Provider Demographics
NPI:1730794454
Name:STANBACK, AUNA
Entity type:Individual
Prefix:
First Name:AUNA
Middle Name:
Last Name:STANBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUNA
Other - Middle Name:
Other - Last Name:STANBACK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ND
Mailing Address - Street 1:4614 CHANNING PARK WAY
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-9298
Mailing Address - Country:US
Mailing Address - Phone:336-830-4078
Mailing Address - Fax:
Practice Address - Street 1:4614 CHANNING PARK WAY
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-9298
Practice Address - Country:US
Practice Address - Phone:336-830-4078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6134225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist